Medicaid. Is it being abused? - page 10

Medicaid was a great idea when first introduced to assure that even the very poor could get quality health care. I just wonder when I see someone drive up in a newer car come up to the triage desk... Read More

  1. by   roosti2000
    You don't have any proof that there is fraud. She may qualify for Medicaid under a waiver program. It is only fraud if she lied about her income on the application, and you haven't told us that any such thing has happened. As for the home visits, that may be something that is covered under your County's public health program. At any rate, it certainly doesn't sound fraudulent. If I was manning the phone of an agency you called and reported this limited information, I'd probably ask you what, exactly, it is that you think should be done.
    ***************

    Do you think the person will tell me how much she declared in an application? Of course not, be realistic! They say that if you have a gut feel, the more reason to believe it that there's soemthing wrong there. She may be in waiver when she first came in this country 7 yrs ago but not able or don't want to update their income. Believe me there's wrong with the situation b/c they can afford to have an SUV, enroll in Bally fitness program, can afford a $1000/mo rent and yet does not pay any medical bill? One time I asked her if she already filed for the income tax, she answered me vaguely, as if she have not filed that her life. I'm fine with people receiving medicaid if they truly deserve it but it so unfair for all people working hard and paying their dues and end up paying for this opportunist medical insurance. That's one of the reason why we are paying more taxes now.
  2. by   steelcityrn
    Any nurse who has worked in the ER can tell you of medicaid abuse. My solution is a ten dollar co-pay for any service that is not a actual classified emergency. Small amount, yet enough to encourage better medical mng. You have to keep it simple. Also as of Jan 1 all medicaid now fall under the medicare drug plans. Too bad those could not have been designed more simpler.
  3. by   mercyteapot
    Quote from roosti2000
    Do you think the person will tell me how much she declared in an application? Of course not, be realistic! They say that if you have a gut feel, the more reason to believe it that there's soemthing wrong there. She may be in waiver when she first came in this country 7 yrs ago but not able or don't want to update their income. Believe me there's wrong with the situation b/c they can afford to have an SUV, enroll in Bally fitness program, can afford a $1000/mo rent and yet does not pay any medical bill? One time I asked her if she already filed for the income tax, she answered me vaguely, as if she have not filed that her life. I'm fine with people receiving medicaid if they truly deserve it but it so unfair for all people working hard and paying their dues and end up paying for this opportunist medical insurance. That's one of the reason why we are paying more taxes now.
    Do I think she answered you truthfully? I have no idea, having never met this person or you. To be perfectly honest, though, if you asked me these questions, I wouldn't bother with vagueness, I'd tell you to mind your own business. You still haven't presented anything to support your allegation that there's fraud here. Maybe there is, but since you have no way of knowing who is paying for all the things you seem to consider luxuries, all you've got is speculation. Good luck getting anyone to take that seriously.
  4. by   flashpoint
    I honestly don't recall seeing any cases of fraud, but I have seen a lot of cases where Medicaid is abused by people who actually need it. We had one couple who came to the ER once a month for a pregnancy test. She came in around the same time every month and said she was late, having cramps, breast tenderness, mood swings, etc and was sure she was pregnant...no one could convince her that she was expereincing PMS and that her period would probably start in a few days...just like last month. As far as I know, she still isn't pregnant. We also see people who bring their kids in because they didn't eat dinner...once. No other symptoms, just didn't eat the tuna casserole or whatever mom made for dinner. We saw a lot of people who were wanting prescriptions for Tylenol, Benadryl, Fleets, etc because they got them for free if they had a prescription. We checked one patient's medical record because we were concerned about the amount of times she was in seeking post-coital contraception...eleven times in three years...refused the pill, patch, etc because they caused weight gain. We saw patients who came in with scratches and papercuts because they needed band-aids...other similar things.

    Unfortunately, most of us never see many of the people who use Medicaid appropriately for just that reason...they don't use it unless they are truly sick...the ones who use it for nonsense are the only ones we see on a regular basis.
  5. by   grannynurse FNP student
    Quote from cotjockey
    I honestly don't recall seeing any cases of fraud, but I have seen a lot of cases where Medicaid is abused by people who actually need it. We had one couple who came to the ER once a month for a pregnancy test. She came in around the same time every month and said she was late, having cramps, breast tenderness, mood swings, etc and was sure she was pregnant...no one could convince her that she was expereincing PMS and that her period would probably start in a few days...just like last month. As far as I know, she still isn't pregnant. We also see people who bring their kids in because they didn't eat dinner...once. No other symptoms, just didn't eat the tuna casserole or whatever mom made for dinner. We saw a lot of people who were wanting prescriptions for Tylenol, Benadryl, Fleets, etc because they got them for free if they had a prescription. We checked one patient's medical record because we were concerned about the amount of times she was in seeking post-coital contraception...eleven times in three years...refused the pill, patch, etc because they caused weight gain. We saw patients who came in with scratches and papercuts because they needed band-aids...other similar things.

    Unfortunately, most of us never see many of the people who use Medicaid appropriately for just that reason...they don't use it unless they are truly sick...the ones who use it for nonsense are the only ones we see on a regular basis.
    You know I would really like to see all the patients who abuse Medicaid, truly I would. I have been a nurse since Medicaid came into being. I have worked in ERs, in a large city and some very small ones. And I have never had the time to check the face sheet, let alone know who was paying the bill. As a matter of fact, I've never seen any of the type of patients that I have seen discribed here. I guess they never came into Kings County or Met, or Elmhurst, in New York City. Or for that matter, Englewood, Manatee or Doctors Hospitals here in Florida. Guess I was just unlucky.

    Last night I went to the ER because of my asthma. The waiting room was crowded, four with apparent leg injuries, a few kids with runny noses and other aliments. Two women, in my age group, also having trouble breathing. And when I talked to one of the ER nurses, she told me that they had been slammed all of her shift, with kids with temps; broken bones; adults with temps, difficulty breathing, chest pain, r/o strokes. I wonder how many of them were on Medicare and Medicaid? Some I am sure. I know of at least one, MYSELF.

    If so many of you are so slammed with fraud by Medicaid patients, why do you not do your civic duty, your civic responsibility and report them. I have reported people for suspect fraud. It is difficult but it is something that can be done. And even if it didn't result in a charge, it got them looked at more closely.

    Grannynurse
  6. by   liljulz0613
    I take SWFlorida's post as a bit offensive. I am 19 years old and I got pregnant when I was 18. I was practicing the correct birth control but things happen. I had to go and get Medicaid for myself and my child because I didn't make enough money with the job I had and my parents weren't going to pay for medical bills once they found out how much it would cost them. I DO NOT in ANY WAY think I am irresponsable just because I got pregnant at a young age and needed some help. I could understand where your coming from if the teenager has no job or stability. But I needed that medicaid help . I support my child on my own without help from parents and I have a job AND am in Nursing school making good grades and my son is the healthiest. If you think people are a BURDEN to society because they have children out of wedlock than its your own opinion I guess. But what about those of us who are RESPONSABLE? I dunno. Reading this just really upset me and hit a nerve because I take care of my son and am not irresponsable in ANY way shape or form. If I am an underachiever dear god please tell me how.
  7. by   flashpoint
    Quote from grannynurse FNP student
    You know I would really like to see all the patients who abuse Medicaid, truly I would. I have been a nurse since Medicaid came into being. I have worked in ERs, in a large city and some very small ones. And I have never had the time to check the face sheet, let alone know who was paying the bill. As a matter of fact, I've never seen any of the type of patients that I have seen discribed here. I guess they never came into Kings County or Met, or Elmhurst, in New York City. Or for that matter, Englewood, Manatee or Doctors Hospitals here in Florida. Guess I was just unlucky.
    Grannynurse
    Well...when you work in an ER that is so small that the nurses take care of doing the admission paperwork (putting informaiton in the computers, copying the insurance cards, etc) you know what type of insurance people have. We also had a bit of an obligation to check insurance because certain providers didn't cover things like portable x-rays (so we would make sure the patient went to the department), ACE bandages (so we made sure the dcotor ordered a cock-up splint), and certan medications. It was a benefit to our patient when we could tell the doctor, "Hey...this won't be covered by their insurance...would you consider _____ instead?"

    I think a lot of it is a regional thing. The hospital where I did my paramedic clinicals did a lot of education about appropriate use of ER...here, they have such a "the customer is always right" attitude that they don't...anything goes in the ER. I think some things like "Ask-a-Nurse" or walk in clinics help keep the overuse of ER to a minumum, but that is something else we don't have here. We also have a HUGE population of people on Medicaid...last year over 70% of out patients were on Medicaid.

    I think a lot of the abuse could be handled with education...also if there were a truly objective way to determine what is an emergency and what is not, I think requiring a copay would help. One of the nurses I used to work with is from Australia and she said that they are a lot more liberal about giving advice on the telephone so that most people try things at home before coming to the ER...that would also help a lot.
  8. by   babynurselsa
    Cotjockey, I experience many of the same things that you do. Every single shift I work.
    I never even bother to look at face sheets. I do not care what a person's paysource is.
    If I find out someone is medicaid it is because they have offered this info. "Tell that doctor to prescribe me something different, my card won't pay for that." "Can you guys get this filled for me, I have already used all my punches this month." This while having spent at LEAST an amount equal to the cost of the prescription at the vending machine, in addition to the cigarettes they have mad a half a dozen trips outside to smoke. I do not care if they have soda or cigarettes What I am saying here is if you can afford them it should be AFTER you have paid for your child's amoxil.
    My complaint would not be that people are on assistance so much in HOW they utilize it. In my state you are assigned a PCP. USE THEM for your mild illness not the local ER.
  9. by   grannynurse FNP student
    Quote from liljulz0613
    I take SWFlorida's post as a bit offensive. I am 19 years old and I got pregnant when I was 18. I was practicing the correct birth control but things happen. I had to go and get Medicaid for myself and my child because I didn't make enough money with the job I had and my parents weren't going to pay for medical bills once they found out how much it would cost them. I DO NOT in ANY WAY think I am irresponsable just because I got pregnant at a young age and needed some help. I could understand where your coming from if the teenager has no job or stability. But I needed that medicaid help . I support my child on my own without help from parents and I have a job AND am in Nursing school making good grades and my son is the healthiest. If you think people are a BURDEN to society because they have children out of wedlock than its your own opinion I guess. But what about those of us who are RESPONSABLE? I dunno. Reading this just really upset me and hit a nerve because I take care of my son and am not irresponsable in ANY way shape or form. If I am an underachiever dear god please tell me how.

    I'm sorry but are you responding to my post? I was not slamming SW Florida, just as I was not slamming NYC. Nor was I slamming anyone on Medicaid or Medicare. And I never have, for several reasons. I began my training when neither program was in place, when family members were responsible for the payment of parents hospital bills. When you had to pre-pay before you could be admitted for surgery And I have received Medicaid twice in my life, at the birth of my daughter and following a bed accident. And I have never seen any of the fraud that I have read about or heard about. And I have repeadly challenged anyone who has to report it and have had no takers. I have been accused as fraudently collect SSDI because I can sit at a computor and go to grad classes. The person making such accusations has never once reported me, even when she knew my correct name. I am very tired of reading over and over of these people who misuse or obtain Medicaid. Like I have said, report them, if you truly believe what you are saying.

    Grannynurse
  10. by   mercyteapot
    Quote from grannynurse FNP student
    I'm sorry but are you responding to my post? I was not slamming SW Florida, just as I was not slamming NYC. Nor was I slamming anyone on Medicaid or Medicare. And I never have, for several reasons. I began my training when neither program was in place, when family members were responsible for the payment of parents hospital bills. When you had to pre-pay before you could be admitted for surgery And I have received Medicaid twice in my life, at the birth of my daughter and following a bed accident. And I have never seen any of the fraud that I have read about or heard about. And I have repeadly challenged anyone who has to report it and have had no takers. I have been accused as fraudently collect SSDI because I can sit at a computor and go to grad classes. The person making such accusations has never once reported me, even when she knew my correct name. I am very tired of reading over and over of these people who misuse or obtain Medicaid. Like I have said, report them, if you truly believe what you are saying.

    Grannynurse
    I don't think her response was to your post, but to the various posts that keep alleging fraud because some people on Medicaid seem to live beyond their means ("seem" being the operative word, because, really, who knows). I also think it is interesting that the question is about "abuse" and the conversation keeps turning to "fraud". Some of us are talking about basic misuse, meaning visiting the ER when a PCP visit (or good old common sense) is appropriate. Others are alleging deception and malfeasance. I would say that yes, this system, like all others, is sometimes abused. And I'm sure there is some fraud, too. You hear a lot more about it on the part of providers and patients, or MC workers and patients, or MC workers and providers, who are in collusion, though. It makes no sense that any great percentage of people who manage to pass the eligibility test are actually living in the circumstances that have been alleged on this board.
  11. by   hope3456
    Quote from obeyacts2
    I believe in CA that once you do get on welfare there is a cap on the grant, meaning a time limit as to how long you amy receive help (5 yrs I think) that is long overdue. Around here they are training the welfare moms to be CNAs!

    Laura
    Good for the state of Cali......reading this takes me back to a couple years ago when I was working as a CNA. I ran into a h.s. friend of mine who was working in a retail store. We were talking, she told me she had a baby and was a single parent - probably got medicaid, I'm sure she would have qualified. She said she was having a hard time making it with this job since she only got scheduled for 17hrs a week and made like 5.70/hr.

    I told her to come work with me, I would help her get hired there. The LTC I was working for was desperate for CNA's and she could work fulltime, $8.00/hr.

    Her response..."Oh, I would NEVER do that type of job."
  12. by   liljulz0613
    No I wasn't posting in response to yours. I ment to reply to a post that was on the first page of the forum. lol. Sorry if it caused any confusion. SWFlorida has made a post that was on the first page and it just hit a nerve. Sorry if my post seems a bit harsh.
  13. by   mercyteapot
    The cap on lifetime welfare benefits isn't limited to California, it is a federal provision. States do run their programs differently, but certain guidelines apply across the board.

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